Counselors and other health practitioners often face situations that require decision-making ability that is sound and ethical. It is because of this reason that the American Counseling Association Committee developed a guide for the practitioners. This book titled A Practitioner’s Guide to Ethical Decision-making provides a framework for decision-making that is ethical and sound. Ethical decision-making models have also been put in place to because problems that are ethical require a lot of social, organizational, legal and personal examination. Mental health, in particular, has a lot of unique issues surrounding it such as legal influence, determining social policies and authority over others.
Decision-making is very important and it is defined as the process identifying and selecting alternatives based on preferences and values. There are numerous decision-making model that mental health practitioners can make use of. These models include the Standards-based model, Principles-based model, Virtues-based model, Moral-reasoning based model (Barrette, 2013). These models are grouped into Practice-Based Model, Social Constructive model and transcultural integrative model (Perry, 2015). All these models are applicable in various fields. This article, however, discusses the practice-based model as an ethical decision-making model that practitioners such as counselors can make use of.
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According to Perry (2015), practice-based models are considered to be pragmatic in nature and are based on some degree of philosophical knowledge of the nature of humans. These guides are practical and offer an approach to decision-making that is step by step. Ethical decision-making models are important because they offer the client protection, it promotes quality practice and care offered by practitioners and it also promotes the development of the counselor and reflective practice. These models have moral principles that govern them such as beneficence where the counselors are expected to work hard to promote the well-being and mental health of clients. The other principle is nonmaleficence where the counselors have to avoid taking any actions that may harm the clients. Ethical decision-making models have an outline with eight steps.
The first step in identifying the problem (Branson and Branson, 2015). This step is the most important because if the right problem is not identified, then the solutions selected will not be effective. When identifying the problem in a particular scenario, the practitioner is expected to gather information pertaining to the problem. One has to identify whether the problem is a legal, ethical, clinical or professional problem. Also, there has to be clear information on the people who will be directly or indirectly affected by the problem at hand. During this process, the counselor is required to consult with the client regularly. In evaluating these questions, the counselor is able to narrow down the general problem to a specific one. This will make the resolution of the problem much easier (Ethical Decision Making, 2017). By breaking down the problem, the counselor is able to examine the problem from various perspectives and come up with the best way forward.
The second step is the application of the relevant codes of ethics such as American Counseling Association ethics. These codes address various issues and that is why counselors have to refer to them. It is important that the counselor goes through the set of codes of ethics and fully comprehend all standards that may apply to the problem and their implications. Some of the challenges that counselors face with their clients who are suffering from mental health can be resolved using the code of ethics (Forester-Miller and Davis, 2016). If there are no codes that deal with the situation at hand then the counselor is facing a complex problem and needs more time to analyze all its aspects and the possible solutions.
The third step is to ascertain the dimensions and nature of the dilemma at hand. In this step, the practitioner has to analyze the implications of the dilemma on the foundation principles such as beneficence, autonomy, loyalty, nonmaleficence, justice, and fidelity (Branson and Branson, 2015). The practitioner has to use their judgment to determine the specific priorities when more than two of the principles are in conflict. The practitioner also has to review all the significant professional literature available at their disposal. Consultation with other experienced healthcare givers who abide by the code of ethics is also recommended. This step is important because experienced personnel is able to identify or see aspects of the problem that the healthcare giver may have not seen. These experienced individuals will also give an unbiased opinion on the matter (Perry, 2015).
The fourth step is the generation of possible courses of action that will be taken by the practitioner. This step is characterized by brainstorming and creativity that enables the practitioner to come up with the best solution (Ethical Decision Making, 2015). When charting the possible courses of action the practitioners have to consider the clinical, ethical and legal ramifications of each potential solution (Perry, 2015). The counselor is expected to list even the solutions that are not likely to work. These solutions will be eliminated when the counselor is narrowing down to the best solutions. Discussions with the experienced practitioners are also encouraged as two minds are better than one.
The consideration of the potential repercussions of all the listed potential solutions and the final determination of the best way to take is the fifth step. Here, all the options are evaluated and all the likely consequences of the options are clearly outlined for all the parties involved whether indirectly or directly. After the consequences are evaluated, the possible implications of the options are also critically thought through. It is also in this step that the elimination of options that will not be the best solutions is done. After the elimination, the remaining options are compared one to another and the best option or combinations of options are identified for use.
Once the best or combination of best opinions have been selected, evaluation takes place. This is done in order to determine if the problem has any new ethical issues or considerations. When doing this evaluation, three tests are done to ensure that it is appropriate. Forester-Miller and Davis (2016) list the first test as the justice test. In this test, the practitioner has to determine whether there is fairness in the solution selected and whether he or she would treat other people in the same manner if a similar situation arises. The publicity test then follows, where the healthcare giver has to ask themselves whether they would want their behavior or decisions reported in the press. This is to determine whether their solution will be credible even in the eyes of the public and that it is the best decision. The final test is the universality test. This test assesses whether the psychologist would be able to suggest the same course of action to another counselor when inquired. In the event that the decision made has any ethical issues or has failed the three tests, then the counselor has to begin from the top because there could be a possibility that the problem was incorrectly identified.
Finally, the last step is the implementation of the best solution to the dilemma at hand (Branson and Branson, 2015). Documentation of the entire process is also important because it can be used as a point of reference and also outlines all the steps that have been made. After implementation, the counselor has to follow up in order to ascertain that the solution has actually solved the problem and the effects expected are achieved. This also shows a good practice on the part of the counselor. It is key that the counselor has a good relationship with the patient so that there is a lot of freedom between them.
It is important to note that different medical practitioners apply different types of ethical decision-making models. There is no model that is above the others because various models tackle various issues. The important thing is that the problems of the patients are addressed. Practitioners have to ensure that they are upholding all the ethical codes that have been laid down for them. They have to ensure that the solutions selected respect the dignity and the rights of their patients, they recognize and respect the autonomy of every individual and appreciates the diversity of human culture and experience. The always have to be competent and supportive while safeguarding their integrity.
Mental health is just as serious as physical health. It has to be keenly dealt with and properly addressed. Patients with conditions that affect their mental health are part of society and interact with a lot of people as well. If their conditions and problems are not addressed, they may end up affecting their family members and those around them in general. The counselors and other medical practitioners have to also be taught on the best way to handle such patients so that they receive the help they need. This is because as much as there are numerous ethical decision-making models today, it is the counselors who make the necessary decisions, not the models.
References
Branson J., S., and Branson, A., (2015). Ethical Decision Making Models. The Counselling Education . Retrieved from https://counseling.education/
Ethical Decision-making, (2015). Eastern Michigan University. Retrieved from https://uk.sagepub .com/sites/default/files/upm-binaries/78085_Chapter_7.pdf
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s Guide to Ethical Decision Making (Rev. ed.). American Counseling Association: The Center for Counseling Practice, Policy, and Research Retrieved from http://www.counseling.org/docs/default-source/ ethics/practioner’s-guide-toethical-decision-making.pdf
Barrett, M., S., (2013). Moral Decision Making. Department of Psychiatry, University of Pennsylvania School of Medicine. Retrieved from https://www.dhss.delaware.gov
Perry, C., F., (2015). A Review of Contemporary Ethical Decision Making Models for Mental Health Professionals. Eastern Michigan University
